The Notice Template Medical is used to create notices for Medical Assistance Program Cases.
Medical Name: This box displays the name of the person selected in the Master Case Person box on the Notice Template window.
Effective Date: Enter the date (MM-DD-YYYY) the notice information will be effective.
Radio Buttons Group Box:
Selecting a radio button for the appropriate notice action enables the required fields.
Begin: Select this radio button when Medical Assistance benefits will begin.
Continue: Select this radio button when Medical Assistance benefits will continue.
Pending: Select this radio button when the Medical Assistance case is pending.
Not Eligible: Select this radio button when the Medical Assistance case is not eligible.
Stop: Select this radio button when the Medical Assistance benefits will stop.
Share of Cost Group Box:
Enter the amount of income that is excess of the Medicaid standard.
POS Group Box:
Nursing Home: Select this check box and complete the amount of the POS (Paid on Other Services) for the nursing home care.
Assisted Living Waiver: Select this check box and complete the amount of the POS (Paid on Other Services) for the assisted living waiver care.
Kids Connection Group Box:
Select this check box if this is a Kids Connection Medical Assistance case.
QMB Group Box:
Select this check box if this is a QMB (Qualified Medicare Beneficiary) case.
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Select the OK button to complete the Medical Notice Template. |
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Select the Cancel button to close the window without creating a Medical Notice Template. |
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Select the Help button to open window help. |
(04-22-03)